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Kehyayan A, Thiel JP, Unterberg K, Salja V, Meyer-Wehrmann S, Holmes EA, Matura JM, Dieris-Hirche J, Timmesfeld N, Herpertz S, Axmacher N, Kessler H. The effect of a visuospatial interference intervention on posttraumatic intrusions: a cross-over randomized controlled trial. Eur J Psychotraumatol 2024; 15:2331402. [PMID: 38591762 PMCID: PMC11028024 DOI: 10.1080/20008066.2024.2331402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 03/02/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Intrusive memories form a core symptom of Posttraumatic Stress Disorder (PTSD). Based on concepts of visuospatial interference and memory-updating accounts, technological innovations aim to attenuate such intrusions using visuospatial interventions.Objective: This study aims to test the effect of a visuospatial Tetris-based intervention versus a verbal condition (Wiki) and a never-targeted control (no intervention) on intrusion frequency.Method: A randomized crossover trial was conducted including N = 38 PTSD patients who had at least 3 distinct intrusive memories of trauma. After both 2 weeks (intervention 1) and 4 weeks (intervention 2), one of the three memories was randomly selected and either the visuospatial intervention (memory reminder of a traumatic memory + Tetris) or verbal condition (reading a Wikipedia article + answering questions) was performed on their first memory in randomized order. In the week 4 session, the patient conducted the other intervention condition on their second memory (crossover). The third memory was never targeted (no intervention). Daily occurrence of intrusions over 8 weeks was collected using a diary and analysed using mixed Poisson regression models.Results: Overall, there was no significant reduction in intrusion frequency from either intervention compared to each other, and to no intervention control (relative risk Tetris/Wiki: 0.947; p = .31; relative risk no intervention/Tetris: 1.060; p = .15; relative risk no intervention/Wiki: 1.004; p = .92).Conclusions: There was no effect of either intervention on intrusions when administered in a crossover design where participants received both interventions. Design shortcomings and consequences for future studies are discussed.
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Affiliation(s)
- Aram Kehyayan
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Josephine P. Thiel
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Karl Unterberg
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Vanessa Salja
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Stefan Meyer-Wehrmann
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Emily A. Holmes
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jan-Martin Matura
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jan Dieris-Hirche
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nikolai Axmacher
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, Campus Fulda, University of Marburg, Fulda, Germany
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Tay KR, Bolt F, Wong HT, Vasileva S, Lee J. Reminder-dependent alterations in long-term declarative memory expression. Neurobiol Learn Mem 2023; 206:107858. [PMID: 37944636 DOI: 10.1016/j.nlm.2023.107858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/20/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
The reminder of a previously-learned memory can render that memory vulnerable to disruption or change in expression. Such memory alterations have been viewed as supportive of the framework of memory reconsolidation. However, alternative interpretations and inconsistencies in the replication of fundamental findings have raised questions particularly in the domain of human declarative memory. Here we present a series of related experiments, all of which involve the learning of a declarative memory, followed 1-2 days later by memory reminder. Post-reminder learning of interfering material did result in modulation of subsequent recall at test, but the precise manifestation of that interference effect differed across experiments. With post-reminder performance of a visuospatial task, a quantitative impairment in test recall performance was observed within a visual list-learning paradigm, but not in a foreign vocabulary learning paradigm. These results support the existence of reminder-induced memory processes that can lead to the alteration of subsequent memory performance by interfering tasks. However, it remains unclear whether these effects are reflective of modulation or impairment of the putative memory reconsolidation process.
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Affiliation(s)
- Kai Rong Tay
- University of Birmingham, School of Psychology, Edgbaston, Birmingham B15 2TT, UK
| | - Francesca Bolt
- University of Birmingham, School of Psychology, Edgbaston, Birmingham B15 2TT, UK
| | - Hei Ting Wong
- University of Birmingham, School of Psychology, Edgbaston, Birmingham B15 2TT, UK
| | - Svetlina Vasileva
- University of Birmingham, School of Psychology, Edgbaston, Birmingham B15 2TT, UK
| | - Jonathan Lee
- University of Birmingham, School of Psychology, Edgbaston, Birmingham B15 2TT, UK.
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Fort D, Deforges C, Messerli-Bürgy N, Michael T, Baud D, Lalor J, Rimmele U, Horsch A. Tackling childbirth-related intrusive memories with a single-session behavioural intervention involving a visuospatial task: protocol for a single-blind, waitlist-controlled randomised trial. BMJ Open 2023; 13:e073874. [PMID: 37247964 DOI: 10.1136/bmjopen-2023-073874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Approximately 12.3% of mothers experience childbirth-related post-traumatic stress symptoms (CB-PTSS). However, evidence-based interventions to treat CB-PTSS are lacking. Intrusive memories (IM), a key CB-PTSS, are distressing and can trigger other PTSS by reliving the traumatic event. Emerging evidence shows that a behavioural intervention involving a visuospatial task (BI-VT) can reduce the number of IM and PTSS, supposedly by interfering with the reconsolidation of the trauma memory. This study aims to test the efficacy of a single-session BI-VT targeting IM to reduce the number of childbirth-related (CB-)IM and PTSS, in comparison to a waitlist control group (WCG). METHODS AND ANALYSIS In this multicentre, single-blind, randomised controlled trial being undertaken at one regional and one university hospital in Switzerland, 60 participants will be allocated to the Immediate Intervention Group (IIG), receiving the immediate intervention on day 15, and 60 participants to the WCG receiving the delayed intervention on day 30. All participants will report their CB-IM during the 2 weeks preimmediate and postimmediate intervention in diaries. The IIG will additionally report their CB-IM over weeks 5 and 6 postimmediate intervention. Self-report questionnaires will assess CB-PTSS at 2 weeks preimmediate and postimmediate intervention in both groups, and at 6 weeks postimmediate intervention in the IIG. A feedback questionnaire will evaluate the intervention acceptability. The primary outcome will be group differences in the number of CB-IM between the 2 weeks preimmediate and postimmediate intervention. Secondary outcomes will be CB-PTSS at 2 and 6 weeks postimmediate intervention, the number of CB-IM at weeks 5 and 6 postimmediate intervention, and intervention acceptability. ETHICS AND DISSEMINATION Ethical approval was granted by the Human Research Ethics Committee of the Canton of Vaud (study number 202200652). Participants will provide an informed consent before study participation. Results will be presented in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER NCT05381155.
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Affiliation(s)
- Déborah Fort
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Camille Deforges
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nadine Messerli-Bürgy
- Family and Development Research Center (FADO), Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | - Ulrike Rimmele
- Emotion and Memory Laboratory, Faculty of Education Sciences and Psychology, University of Geneva, Geneva, Switzerland
- Swiss Center for Affective Sciences (CISA), University of Geneva, Geneva, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Neonatology Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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4
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Xu Z, Hu J, Wang Y. Bilateral eye movements disrupt the involuntary perceptual representation of trauma-related memories. Behav Res Ther 2023; 165:104311. [PMID: 37037182 DOI: 10.1016/j.brat.2023.104311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 04/12/2023]
Abstract
Bilateral eye movement (EM) is a critical component in eye movement desensitization and reprocessing (EMDR), an effective treatment for post-traumatic stress disorder. However, the role of bilateral EM in alleviating trauma-related symptoms is unclear. Here we hypothesize that bilateral EM selectively disrupts the perceptual representation of traumatic memories. We used the trauma film paradigm as an analog for trauma experience. Nonclinical participants viewed trauma films followed by a bilateral EM intervention or a static Fixation period as a control. Perceptual and semantic memories for the film were assessed with different measures. Results showed a significant decrease in perceptual memory recognition shortly after the EM intervention and subsequently in the frequency and vividness of film-related memory intrusions across one week, relative to the Fixation condition. The EM intervention did not affect the explicit recognition of semantic memories, suggesting a dissociation between perceptual and semantic memory disruption. Furthermore, the EM intervention effectively reduced psychophysiological affective responses, including the skin conductance response and pupil size, to film scenes and subjective affective ratings of film-related intrusions. Together, bilateral EMs effectively reduce the perceptual representation and affective response of trauma-related memories. Further theoretical developments are needed to elucidate the mechanism of bilateral EMs in trauma treatment.
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Affiliation(s)
- Zhenjie Xu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310028, Zhejiang, China
| | - Jie Hu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310028, Zhejiang, China
| | - Yingying Wang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310028, Zhejiang, China.
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5
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Asselbergs J, van Bentum J, Riper H, Cuijpers P, Holmes E, Sijbrandij M. A systematic review and meta-analysis of the effect of cognitive interventions to prevent intrusive memories using the trauma film paradigm. J Psychiatr Res 2023; 159:116-129. [PMID: 36708636 DOI: 10.1016/j.jpsychires.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
There is an unmet need for effective early interventions that can relieve initial trauma symptoms and reduce symptoms of posttraumatic stress disorder (PTSD). We evaluated the efficacy of cognitive interventions compared to control in reducing intrusion frequency and PTSD symptoms in healthy individuals using the trauma film paradigm, in which participants view a film with aversive content as an experimental analogue of trauma exposure. A systematic literature search identified 41 experiments of different cognitive interventions targeting intrusions. In the meta-analysis, the pooled effect size of 52 comparisons comparing cognitive interventions to no-intervention controls on intrusions was moderate (g = -0.46, 95% CI [-0.61 to -0.32], p < .001). The pooled effect size of 16 comparisons on PTSD symptoms was also moderate (g = -0.31, 95% CI [-0.46 to -0.17], p < .001). Both visuospatial interference and imagery rescripting tasks were associated with significantly fewer intrusions than controls, whereas verbal interference and meta-cognitive processing tasks showed nonsignificant effect sizes. Interventions administered after viewing the trauma film showed significantly fewer intrusions than controls, whereas interventions administered during film viewing did not. No experiments had low risk of bias (ROB), 37 experiments had some concerns of ROB, while the remaining four experiments had high ROB. To the best of our knowledge, this is the first meta-analysis investigating the efficacy of cognitive interventions targeting intrusions in non-clinical samples. Results seem to be in favour of visuospatial interference tasks rather than verbal tasks. More research is needed to develop an evidence base on the efficacy of various cognitive interventions and test their clinical translation to reduce intrusive memories of real trauma.
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Affiliation(s)
- Joost Asselbergs
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands
| | - Jaёl van Bentum
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Faculty of Social and Behavioural Sciences, Dept. of Clinical Psychology, Universiteit Utrecht, Heidelberglaan 1, 3584 CS, Utrecht, Netherlands.
| | - Heleen Riper
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Medical Centre, VUmc, Dept. of Psychiatry, Amsterdam, the Netherlands; Research Unit for Telepsychiatry and E-Mental Health, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense, Denmark
| | - Pim Cuijpers
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania; WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, the Netherlands
| | - Emily Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Marit Sijbrandij
- Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Vrije Universiteit Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands; WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, the Netherlands
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6
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Singh L, Ahmed Pihlgren S, Holmes EA, Moulds ML. Using a daily diary for monitoring intrusive memories of trauma: A translational data synthesis study exploring convergent validity. Int J Methods Psychiatr Res 2023; 32:e1936. [PMID: 35976618 PMCID: PMC9976599 DOI: 10.1002/mpr.1936] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/16/2022] [Accepted: 08/01/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Intrusive memories are a core feature of posttraumatic stress disorder and have transdiagnostic relevance across mental disorders. Establishing flexible methods to monitor intrusions, including patterns and characteristics, is a key challenge. A daily diary has been developed in experimental settings to provide symptom count data, without the need for retrospective self-report over extended time periods (e.g., 1 week, 1 month). We conducted an exploratory, pre-registered data synthesis investigating convergence between the diary and questionnaire measures of intrusive symptoms long used in clinical practice (Impact of Event Scale, IES, and revised version, IES-R, Intrusion subscale). RESULTS Utilising datasets using the daily diary from 11 studies (4 real-world trauma studies, seven analogue trauma studies; total N = 578), we found significant positive associations between the diary and IES/IES-R Intrusion subscale. Exploratory analyses indicated that the magnitude of this association was stronger for the IES (vs. the IES-R), and in individuals with real-world (vs. analogue) trauma. CONCLUSION This study provides first evidence of convergent validity of a daily diary for monitoring intrusions with a widely used questionnaire. A diary may be a more flexible methodology to obtain information about intrusions (frequency, characteristics, triggers, content), relative to questionnaires which rely on retrospective reporting of symptoms over extended timeframes. We discuss potential benefits of daily monitoring of intrusions in clinical and research contexts.
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Affiliation(s)
- Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Swedish Collegium for Advanced Study, Uppsala, Sweden
| | | | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Michelle L Moulds
- School of Psychology, UNSW Sydney, Sydney, New South Wales, Australia
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7
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Jiang C, Chen W, Tao L, Wang J, Cheng K, Zhang Y, Qi Z, Zheng X. Game-matching background music has an add-on effect for reducing emotionality of traumatic memories during reconsolidation intervention. Front Psychiatry 2023; 14:1090290. [PMID: 36873205 PMCID: PMC9974640 DOI: 10.3389/fpsyt.2023.1090290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Hospital is a stressful place of employment, and a high proportion of healthcare workers, especially the ICU (Intensive Care Unit) nurses were found to be at risk of PTSD. Previous studies showed that taxing working memory through visuospatial tasks during the reconsolidation process of aversive memories can reduce the number of intrusions afterwards. However, the finds could not be replicated by some researches, indicating there may be some boundary conditions that are subtle and complex. METHODS We performed a randomized controlled trial (ChiCTR2200055921; URL: www.chictr.org.cn). In our study, a series of ICU nurses or probationers who performed a cardiopulmonary resuscitation (CPR) were enrolled and instructed to play a visuospatial music tapping game ("Ceaseless Music Note", CMN; Beijing Muyuan Technology Co., Ltd., Beijing, China) at the fourth day after CPR. The numbers of intrusions each day were recorded from the first to the seventh days (24 h×6 day), and the vividness and emotionality of CPR memories were rated at the 4th and 7th days. These parameters were compared between different groups (game with background sound; game with sound off; sound only; none). RESULTS The game-matching background music can have an add-on effect for single tapping game with no sound in reducing the emotionality of previous aversive memories. DISCUSSION We proposed that flow experience (the subjective experience of effortless attention, reduced self-awareness, and enjoyment, and may be induced by optimal skill-demands compatibility in challenging tasks) as a key boundary condition for successful reconsolidation intervention. CLINICAL TRIAL REGISTRATION www.chictr.org.cn, identifier: ChiCTR2200055921.
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Affiliation(s)
- Che Jiang
- School of Psychology, South China Normal University, Guangzhou, China.,Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Wei Chen
- School of Psychology, South China Normal University, Guangzhou, China
| | - Ling Tao
- Computer Engineering Technical College, Guangdong Polytechnic of Science and Technology, Guangzhou, China
| | - Jiajia Wang
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Kuihong Cheng
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Yibo Zhang
- Department of Neurosurgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Zijuan Qi
- Department of Neurology, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Xifu Zheng
- School of Psychology, South China Normal University, Guangzhou, China
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8
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Mathew AS, Lotfi S, Bennett KP, Larsen SE, Dean C, Larson CL, Lee HJ. Association between spatial working memory and Re-experiencing symptoms in PTSD. J Behav Ther Exp Psychiatry 2022; 75:101714. [PMID: 34906826 PMCID: PMC9173718 DOI: 10.1016/j.jbtep.2021.101714] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/13/2021] [Accepted: 12/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Few studies have evaluated the link between working memory (WM) and post-traumatic stress disorder (PTSD). Further, it is unknown whether this relationship is accounted for by other relevant variables including negative affect, emotional dysregulation, or general non-WM-related cognitive control deficits, which are associated with PTSD. The purpose of this study was to determine the extent to which a computerized WM task could predict PTSD symptomology incrementally beyond the contribution of other relevant variables associated with PTSD. METHODS Thirty veterans were eligible to complete emotional symptom questionnaires, a heart-rate variability measure, and computerized tasks (i.e., emotional Stroop and automated complex span tasks). A three-stage hierarchical regression was conducted with the PCL-5 total score and symptom clusters (i.e., re-experiencing, avoidance, hyperarousal, and negative cognition/mood) as the dependent variable. RESULTS Results revealed that only the re-experiencing symptom cluster was significantly predicted by executive, verbal, and visuospatial WM tasks, which explained an additional 29.7% of the variance over and above other relevant variables. Most notably, the visuospatial task was the only WM task that significantly explained PCL-5 re-experiencing symptoms. LIMITATIONS This study was based on a small sample of veterans with PTSD and causality cannot be determined with this cross-sectional study. CONCLUSIONS Overall, the results suggest that deficits in visuospatial WM are significantly associated with PTSD re-experiencing symptoms after controlling for other relevant variables. Further research should evaluate whether an intervention to improve visuospatial WM capacity can be implemented to reduce re-experiencing symptoms.
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Affiliation(s)
- Abel S Mathew
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | - Salahadin Lotfi
- Department of Psychology, University of Wisconsin-Milwaukee, USA; Rogers Behavioral Health, Research Center and Clinical Effectiveness Department, USA
| | | | - Sadie E Larsen
- Milwaukee VA Medical Center, USA; Medical College of Wisconsin, USA
| | - Caron Dean
- Milwaukee VA Medical Center, USA; Medical College of Wisconsin, USA
| | | | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, USA.
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No evidence for disruption of reconsolidation of conditioned threat memories with a cognitively demanding intervention. Sci Rep 2022; 12:6663. [PMID: 35459769 PMCID: PMC9033821 DOI: 10.1038/s41598-022-10184-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 03/04/2022] [Indexed: 12/22/2022] Open
Abstract
Simultaneous execution of memory retrieval and cognitively demanding interventions alter the subjective experience of aversive memories. This principle can be used in treatment to target traumatic memories. An often-used interpretation is that cognitive demand interferes with memory reconsolidation. Laboratory models applying this technique often do not meet some important procedural steps thought necessary to trigger reconsolidation. It remains therefore unclear whether cognitively demanding interventions can alter the reconsolidation process of aversive memories. Here, 78 (41 included) healthy participants completed an established 3-day threat conditioning paradigm. Two conditioned stimuli were paired with a shock (CS+ s) and one was not (CS-). The next day, one CS+ (CS+ R), but not the other (CS+), was presented as a reminder. After 10 min, participants performed a 2-back working memory task. On day three, we assessed retention. We found successful acquisition of conditioned threat and retention (CS+ s > CS-). However, SCRs to the CS+ R and the CS+ during retention did not significantly differ. Although threat conditioning was successful, the well-established cognitively demanding intervention did not alter the reconsolidation process of conditioned threat memories. These findings challenge current views on how cognitively demand may enhance psychotherapy-outcome.
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10
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Deforges C, Fort D, Stuijfzand S, Holmes EA, Horsch A. Reducing childbirth-related intrusive memories and PTSD symptoms via a single-session behavioural intervention including a visuospatial task: A proof-of-principle study. J Affect Disord 2022; 303:64-73. [PMID: 35108604 DOI: 10.1016/j.jad.2022.01.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/03/2021] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intrusive memories (IMs) of traumatic events are a key symptom of posttraumatic stress disorder (PTSD), and contribute to its maintenance. This translational proof-of-principle study tested whether a single-session behavioural intervention reduced the number of childbirth-related IMs (CB-IMs) and childbirth-related PTSD (CB-PTSD) symptoms, in women traumatised by childbirth. The intervention was assumed to disrupt trauma memory reconsolidation. METHODS In this pre-post study, 18 participants, whose traumatic childbirth had occurred between seven months and 6.9 years before, received an intervention combining childbirth-related reminder cues (including the return to maternity unit) with a visuospatial task. They recorded their daily CB-IMs in the two weeks pre-intervention (diary 1), the two weeks post-intervention (diary 2; primary outcome), and in week 5 and 6 post-intervention (diary 3). CB-PTSD symptom severity was assessed five days pre-intervention and one month post-intervention. RESULTS Compared to diary 1, 15/18 participants had ≥ 50% fewer CB-IMs in diary 2. The median (IQR) reduction of the number of CB-IMs was 81.89% (39.58%) in diary 2, and persisted in diary 3 (n = 17). At one month post-intervention, CB-PTSD symptom severity was reduced by ≥ 50% in 10/18 participants. Of the 8 participants with a CB-PTSD diagnosis pre-intervention, none met diagnostic criteria post-intervention. The intervention was rated as highly acceptable. LIMITATIONS The design limits the causal interpretation of observed improvements. CONCLUSION This is the first time such a single-session behavioural intervention was tested for old and real-life single-event trauma. The promising results justify a randomized controlled trial, and may be a first step toward an innovative CB-PTSD treatment.
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Affiliation(s)
- Camille Deforges
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - Déborah Fort
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - Suzannah Stuijfzand
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland; Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
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11
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Hudson M, Johnson MI. Split-Second Unlearning: Developing a Theory of Psychophysiological Dis-ease. Front Psychol 2021; 12:716535. [PMID: 34912263 PMCID: PMC8666476 DOI: 10.3389/fpsyg.2021.716535] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/08/2021] [Indexed: 11/20/2022] Open
Abstract
Psychophysiological “stress” underpins many conditions including anxiety, depression, phobias, chronic fatigue syndrome and non-specific musculoskeletal pain such as fibromyalgia. In this article we develop an understanding of chronic psychophysiological stress from a psychological educational perspective, by drawing on supporting evidence that significant emotional events in early life (traumatic and benign) can influence health and well-being later in life. We suggest that traumatic events instigate psychophysiological “stress” responses and the formation of emotional memory images (EMIs) within very short time frames, i.e., “split-second learning.” Once formed these emotional memories are triggered in daily living “re-playing” psychophysiological stress responses, resulting in chronic psychophysiological “dis-ease.” We describe a novel therapeutic approach to scan clients for mannerisms signifying a subconscious “freeze-like” stress response that involves the client as a curious observer within their own experience, feeding back the non-verbal cues as they arrive in the moment. By breaking down the observable fragments of their split-second Pavlovian response to the trigger, clients can detach their EMI from the psychophysiology stress response, i.e., “split-second unlearning.” Our split-second unlearning model recognizes the EMI as a barrier to moving forward and needs to be unlearned before the client can become naturally adaptive again. We argue that this approach places the client at the center of the work without the need of getting bogged down in a life-long narrative.
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Affiliation(s)
| | - Mark I Johnson
- Centre for Pain Research, Leeds Beckett University, Leeds, United Kingdom
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12
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Herz N, Bar-Haim Y, Tavor I, Tik N, Sharon H, Holmes EA, Censor N. Neuromodulation of Visual Cortex Reduces the Intensity of Intrusive Memories. Cereb Cortex 2021; 32:408-417. [PMID: 34265849 PMCID: PMC8754386 DOI: 10.1093/cercor/bhab217] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 12/24/2022] Open
Abstract
Aversive events can be reexperienced as involuntary and spontaneous mental images of the event. Given that the vividness of retrieved mental images is coupled with elevated visual activation, we tested whether neuromodulation of the visual cortex would reduce the frequency and negative emotional intensity of intrusive memories. Intrusive memories of a viewed trauma film and their accompanied emotional intensity were recorded throughout 5 days. Functional connectivity, measured with resting-state functional magnetic resonance imaging prior to film viewing, was used as predictive marker for intrusions-related negative emotional intensity. Results indicated that an interaction between the visual network and emotion processing areas predicted intrusions’ emotional intensity. To test the causal influence of early visual cortex activity on intrusions’ emotional intensity, participants’ memory of the film was reactivated by brief reminders 1 day following film viewing, followed by inhibitory 1 Hz repetitive transcranial magnetic stimulation (rTMS) over early visual cortex. Results showed that visual cortex inhibitory stimulation reduced the emotional intensity of later intrusions, while leaving intrusion frequency and explicit visual memory intact. Current findings suggest that early visual areas constitute a central node influencing the emotional intensity of intrusive memories for negative events. Potential neuroscience-driven intervention targets designed to downregulate the emotional intensity of intrusive memories are discussed.
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Affiliation(s)
- Noa Herz
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ido Tavor
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Niv Tik
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Haggai Sharon
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel.,Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala 75142, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Solna 17177, Sweden
| | - Nitzan Censor
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 69978, Israel
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13
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Woud ML, Blackwell SE, Shkreli L, Würtz F, Cwik JC, Margraf J, Holmes EA, Steudte-Schmiedgen S, Herpertz S, Kessler H. The Effects of Modifying Dysfunctional Appraisals in Posttraumatic Stress Disorder Using a Form of Cognitive Bias Modification: Results of a Randomized Controlled Trial in an Inpatient Setting. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:386-402. [PMID: 33621970 DOI: 10.1159/000514166] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/04/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Dysfunctional appraisals about traumatic events and their sequelae are a key mechanism in posttraumatic stress disorder (PTSD). Experimental studies have shown that a computerized cognitive training, cognitive bias modification for appraisals (CBM-APP), can modify dysfunctional appraisals and reduce analogue trauma symptoms amongst healthy and subclinical volunteers. OBJECTIVE We aimed to test whether CBM-APP could reduce dysfunctional appraisals related to trauma reactions in PTSD patients, and whether this would lead to improvements in PTSD symptoms. METHODS We compared CBM-APP to sham training in a parallel-arm proof-of-principle double-blind randomized controlled trial amongst 80 PTSD patients admitted to an inpatient clinic. Both arms comprised a training schedule of 8 sessions over a 2-week period and were completed as an adjunct to the standard treatment programme. RESULTS In intention-to-treat analyses, participants receiving CBM-APP showed a greater reduction in dysfunctional appraisals on a scenario task from pre- to posttraining (primary outcome) assessments, compared to those receiving sham training (d = 1.30, 95% CI 0.82-1.80), with between-group differences also found on the Posttraumatic Cognitions Inventory (PTCI; d = 0.85, 95% CI 0.39-1.32) and the PTSD Checklist for DSM-5 (PCL-5; d = 0.68, 95% CI 0.23-1.14), but not for long-term cortisol concentrations (d = 0.25, 95% CI -0.28 to 0.78). Reductions in dysfunctional appraisals assessed via the scenario task correlated with reductions on the PTCI, PCL-5, and hair cortisol concentrations from pre- to posttraining time points. CONCLUSIONS Results support dysfunctional appraisals as a modifiable cognitive mechanism, and that their proximal modification transfers to downstream PTSD symptoms. These findings could open new avenues for improving present therapeutic approaches.
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Affiliation(s)
- Marcella L Woud
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany,
| | - Simon E Blackwell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Lorika Shkreli
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Felix Würtz
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Jan Christopher Cwik
- Clinical Psychology and Psychotherapy, Department of Human Sciences, University of Cologne, Cologne, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany
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The Role of the Thalamus in Post-Traumatic Stress Disorder. Int J Mol Sci 2021; 22:ijms22041730. [PMID: 33572198 PMCID: PMC7915053 DOI: 10.3390/ijms22041730] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/11/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) has a high lifetime prevalence and is one of the more serious challenges in mental health care. Fear-conditioned learning involving the amygdala has been thought to be one of the main causative factors; however, recent studies have reported abnormalities in the thalamus of PTSD patients, which may explain the mechanism of interventions such as eye movement desensitization and reprocessing (EMDR). Therefore, I conducted a miniature literature review on the potential contribution of the thalamus to the pathogenesis of PTSD and the validation of therapeutic approaches. As a result, we noticed the importance of the retinotectal pathway (superior colliculus−pulvinar−amygdala connection) and discussed therapeutic indicators.
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15
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Morales-Rivero A, Reyes-Santos L, Bisanz E, Ruiz-Chow A, Crail-Melendez D. The effect of motor interference therapy in traumatic memories: A pilot study. Brain Behav 2021; 11:e01984. [PMID: 33314729 PMCID: PMC7882170 DOI: 10.1002/brb3.1984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/04/2020] [Accepted: 11/20/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Traumatic memories of events such as a life-threatening incident, serious injury, or sexual violence are a core symptom of stress-related disorders; they might be susceptible to positive modification with interference tasks (reconsolidation-based interventions). Our objective was to test the effect of performing a motor interference task (finger tapping in response to audio cues) on patients who suffer from traumatic memories. METHODS We designed an uncontrolled pilot prospective clinical trial. Ten participants listened to an audio track that instructed them to tap their fingers in response to specific audio cues while trying to recall the traumatic event. Each patient underwent an assessment including the Spanish version of the PTSD Symptom Severity Scale-Revised (EGS-R), the visual analogue scale (EQ-VAS) from EuroQol 5D (EQ-5D), and a simple visual analogue scale (VAS) before the intervention, immediately after, and a week after the treatment. RESULTS All measures exhibited a statistically significant improvement 1 week after the study. On the PTSD scale, 1 week later, 30% of the patients did not score high enough for such diagnosis. The VAS measured immediately following the intervention (4.4, SD = 2.22) also improved (p < .001), and 30% of the patients scored zero. One week after the intervention, the VAS improved more than 50% CONCLUSION: The rapid 1-week improvement on the PSTD scale and the VAS after a 30 min intervention support the idea of further research using a double-blind, controlled design powered to demonstrate the efficacy of motor interference, an easy-to-apply therapeutic tool, in the treatment of traumatic memories.
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Affiliation(s)
- Alonso Morales-Rivero
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Lorena Reyes-Santos
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Erik Bisanz
- University of British Columbia, Vancouver, BC, Canada
| | - Angel Ruiz-Chow
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Daniel Crail-Melendez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.,Faculty of Medicine, UNIVERSIDAD NACIONAL AUTONOMA DE MEXICO, Mexico City, Mexico
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Kanstrup M, Singh L, Göransson KE, Widoff J, Taylor RS, Gamble B, Iyadurai L, Moulds ML, Holmes EA. Reducing intrusive memories after trauma via a brief cognitive task intervention in the hospital emergency department: an exploratory pilot randomised controlled trial. Transl Psychiatry 2021; 11:30. [PMID: 33431807 PMCID: PMC7798383 DOI: 10.1038/s41398-020-01124-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023] Open
Abstract
Intrusive memories are common after trauma, and can cause significant distress. Interventions to prevent/reduce the occurrence of this core clinical feature of posttraumatic stress disorder are needed; they should be easy to deliver, readily disseminated and scalable. A novel one-session intervention by Iyadurai et al. 2018, Molecular Psychiatry, resulted in intrusion reduction over the subsequent week. Its feasibility in a different setting and longer-term effects (>1 month) need investigation. We conducted an exploratory open-label pilot randomised controlled trial (RCT) to investigate the feasibility and effects of a brief behavioural intervention to reduce intrusive memories in trauma-exposed patients in a Swedish hospital emergency department (ED). Participants (final N = 41) were randomly allocated to either intervention (including memory reminder cue then visuospatial cognitive task "Tetris" with mental rotation instructions) or active control (podcast) condition within 72 h of presenting to the ED (both conditions using their smartphone). Findings were examined descriptively. We estimated between-group effect sizes for the number of intrusive memories post-intervention at week 1 (primary outcome) and week 5 (secondary outcome). Compared to the control condition, participants in the intervention condition reported fewer intrusive memories of trauma, both at week 1 and week 5. Findings extend the previous evaluation in the UK. The intervention was readily implemented in a different international context, with a mixed trauma sample, with treatment gains maintained at 1 month and associated with some functional improvements. Findings inform future trials to evaluate the capacity of the cognitive task intervention to reduce the occurrence of intrusive memories after traumatic events.
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Affiliation(s)
- Marie Kanstrup
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Functional Area Medical Psychology, Karolinska University Hospital, Stockholm, Sweden.
| | - Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Katarina E Göransson
- Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Julia Widoff
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Beau Gamble
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | | | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW Sydney, Sydney, Australia
| | - Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
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17
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Brennen T, Blix I, Nissen A, Holmes EA, Skumlien M, Solberg Ø. Investigating the frequency of intrusive memories after 24 hours using a visuospatial interference intervention: a follow-up and extension. Eur J Psychotraumatol 2021; 12:1953788. [PMID: 34408817 PMCID: PMC8366629 DOI: 10.1080/20008198.2021.1953788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There is a need for effective, low-cost, readily available measures for reducing trauma symptoms so that people exposed to potentially traumatic events can receive help more quickly. A previous study reported that performing an intervention including a visuospatial task shortly after a reminder of a series of unpleasant film clips seen 24 hours earlier reduced the number of intrusive memories over the following week. OBJECTIVE This study reports a follow-up and extension of the earlier promising finding. The prediction was that participants performing the visuospatial task immediately after the reminder would report fewer intrusions compared to three other groups who 1) performed no task, and novel conditions who 2) performed the task before the reminder, and 3) performed the task 90 minutes after the reminder. METHOD A trauma-analogue method was used, where students (N = 200) watched a series of short films with unpleasant material. Over the following week, they were asked to write down any intrusive memories they experienced in a diary. On the second day they returned to the lab and saw static reminders of the films. They were then randomly allocated to condition, recorded intrusive memories over the following days and returned to the lab for final testing on Day 8. RESULTS A total of 49 participants did not report any intrusions and were excluded from the analyses. Two more participants were excluded as outliers, leaving a final sample of n = 149. Despite using largely the same materials as the original study there were no significant differences in the number of intrusive memories between the four groups post intervention. CONCLUSIONS Possible explanations include the effect not being as robust as expected, a low number of intrusions across groups, baseline differences in attention, and minor but potentially important differences in procedure between this and the original study.
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Affiliation(s)
- Tim Brennen
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Ines Blix
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Alexander Nissen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Øivind Solberg
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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Kessler H, Dangellia L, Herpertz S, Kehyayan A. [Digital Media in Psychotherapy - New Approaches and Perspectives in the Treatment of Trauma-Related Disorders]. Psychother Psychosom Med Psychol 2020; 70:371-377. [PMID: 32252120 DOI: 10.1055/a-1120-8976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article provides an insight into novel approaches and perspectives using digital technologies in the treatment of trauma-related disorders. Therapy options for patients with trauma-related disorders are not easily available on a global scale and there is a search for new specific therapeutic strategies. In the first part of this article, examples of digital approaches are provided that are based on established analogue treatments and are designed mainly to increase availability and cost-effectiveness of these treatments. In the second part, the focus lies on digital treatments that employ novel approaches, which are e. g. informed by cognitive science, to specifically target particular symptoms in clinical populations after their development in lab studies. Examples given are visuospatial interventions used to reduce intrusive symptoms, or training programmes to increase levels of interference control (to control trauma-related stimuli), or to change automatic dysfunctional cognitions. These interventions will be presented with their respective theoretical frameworks, along with results from first (partially clinical) studies, which are promising concerning acceptance, applicability and effectiveness.
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Affiliation(s)
- Henrik Kessler
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
| | - Luisa Dangellia
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
| | - Stephan Herpertz
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
| | - Aram Kehyayan
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
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19
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Kanstrup M, Kontio E, Geranmayeh A, Olofsdotter Lauri K, Moulds ML, Holmes EA. A single case series using visuospatial task interference to reduce the number of visual intrusive memories of trauma with refugees. Clin Psychol Psychother 2020; 28:109-123. [PMID: 32525244 DOI: 10.1002/cpp.2489] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/07/2022]
Abstract
The current worldwide so-called "refugee crisis" has led to an unprecedented increase in migration globally. Because of stigma and language barriers, mental health care for refugees is limited. There is a need for novel, scalable psychological interventions. We investigated whether a brief behavioural intervention involving a memory reminder cue and Tetris gameplay on a smartphone reduces intrusive memories in refugees using a single case (N = 4) ABAB withdrawal design. The baseline phase (A) included a no-intervention week; the intervention phase (B) included an in-person session with the researchers, comprised of the behavioural intervention followed by self-guided use in daily life the following week. All participants reported a decrease in intrusive memories after the intervention, as well as functional improvements (e.g., in concentration). Importantly, participants rated the intervention as feasible and acceptable. As one in-person session was effective in persistent intrusion reduction, ABAB proved not to be the optimal design as intrusions did not rebound in the withdrawal phase. Findings are promising and highlight the need for further evaluation of novel interventions for mental health problems in refugees.
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Affiliation(s)
- Marie Kanstrup
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Evelina Kontio
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anahita Geranmayeh
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Klara Olofsdotter Lauri
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Michelle L Moulds
- Department of Psychology, Uppsala University, Uppsala, Sweden.,School of Psychology, The University of New South Wales, UNSW, Sydney, New South Wales, Australia
| | - Emily A Holmes
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Uppsala University, Uppsala, Sweden
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Abstract
BACKGROUND Even in cases with complexity, simple techniques can be useful to target a specific symptom. Intrusive mental images are highly disruptive, drive emotion, and contribute to maintaining psychopathology. Cognitive science suggests that we might target intrusive images using competing tasks. AIMS We describe an imagery competing task technique within cognitive behavioural therapy (CBT) with a patient with bipolar disorder and post-traumatic stress disorder (PTSD) symptoms. The intervention - including Tetris computer game-play - was used (1) to target a specific image within one therapy session, and (2) to manage multiple images in daily life. METHOD A single case (AB) design was used. (1) To target a specific image, the patient brought the image to mind and, after mental rotation instructions and game-play practice, played Tetris for 10 minutes. Outcomes, pre- and post-technique, were: vividness/distress ratings when the image was brought to mind; reported intrusion frequency over a week. (2) To manage multiple images, the patient used the intervention after an intrusive image occurred. Outcomes were weekly measures of: (a) imagery characteristics; (b) symptoms of PTSD, anxiety, depression and mania. RESULTS (1) For the target image, there were reductions in vividness (80% to 40%), distress (70% to 0%), and intrusion frequency (daily to twice/week). (2) For multiple images, there were reductions from baseline to follow-up in (a) imagery vividness (38%), realness (66%) and compellingness (23%), and (b) PTSD symptoms (Impact of Events Scale-Revised score 26.33 to 4.83). CONCLUSION This low-intensity intervention aiming to directly target intrusive mental imagery may offer an additional, complementary tool in CBT.
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21
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Arresting visuospatial stimulation is insufficient to disrupt analogue traumatic intrusions. PLoS One 2020; 15:e0228416. [PMID: 32012193 PMCID: PMC6999047 DOI: 10.1371/journal.pone.0228416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/14/2020] [Indexed: 11/19/2022] Open
Abstract
Intrusive memories are a core symptom of Post-Traumatic Stress Disorder (PTSD). A growing body of analogue studies using trauma films suggest that carrying out specific demanding tasks (e.g., playing the video game Tetris, pattern tapping) after the analogue trauma can reduce intrusive memories. To examine the mechanism behind this effect, we tested whether mere engagement with attention-grabbing and interesting visual stimuli disrupts intrusive memories, and whether this depends on working memory resources and/or the concurrent activation of trauma film memories. In a total sample of 234 healthy participants, we compared no-task control conditions to a perceptual rating task with visually arresting video clips (i.e., non-emotional, complex, moving displays), to a less arresting task with non-moving, blurred pictures (Study 1), and to more demanding imagery tasks with and without repetitive reminders of the trauma film (Study 2). Generally, we found moderate to strong evidence that none of the conditions lead to differences in intrusion frequency. Moreover, our data suggest that intrusive memories were neither related to individual differences in working memory capacity (i.e., operation span performance; Study 1), nor to the degree of engagement with a visuospatial task (i.e., one-week recognition performance; Study 2). Taken together, our findings suggest that the boundary conditions for successful interference with traumatic intrusions may be more complex and subtle than assumed. Future studies may want to test the role of prediction errors during (re-)consolidation, deliberate efforts to suppress thoughts, or the compatibility of the task demands with the individual's skills.
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22
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Kessler H, Dangellia L, Kessler R, Mahnke V, Herpertz S, Kehyayan A. Mobilum-a new mobile app to engage visuospatial processing for the reduction of intrusive visual memories. Mhealth 2019; 5:49. [PMID: 31853450 PMCID: PMC6917555 DOI: 10.21037/mhealth.2019.09.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 09/19/2019] [Indexed: 01/07/2023] Open
Abstract
Intrusive memories are a key symptom of posttraumatic stress disorder (PTSD), a prevalent condition causing considerable personal suffering, and entailing large direct and indirect societal costs. While effective treatment options for PTSD exist, on a global scale they are not readily available to many patients in need. In the last years, several studies have shown that the computer game Tetris can reduce the frequency of intrusive memories in healthy subjects (after a trauma analogue), in populations at high risk of developing PTSD, as well as in patients already suffering from PTSD. The presumed mechanism behind this effect is that both Tetris and intrusions require-and therefore compete for-limited visuospatial working memory resources. In search for a new alternative tool that can engage visuospatial processing as effectively as Tetris, we developed a game named Mobilum. This is an app for Android devices, in which users have to rotate in an imaginative way around a translucent virtual cube in order to decide from which perspective a complex three-dimensional figure inside the cube is seen. Mobilum was developed to investigate whether the intrusion-reducing effect is exclusively inherent to Tetris, or if it can be achieved with another task engaging users in visuospatial processing. Also, unlike available versions of Tetris, Mobilum offers full control over key game parameters (e.g., difficulty, game duration), and is free of copyright and commercial issues. In this method paper, we describe the new Mobilum app, its theoretical background and development. Additionally, the first data on usability and feasibility are reported, as rated by N=16 inpatients. Finally, we will provide an outlook on the next steps necessary to investigate Mobilum's potential as a therapeutic tool.
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Affiliation(s)
- Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Luisa Dangellia
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | | | | | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Aram Kehyayan
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
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Woud ML, Heeren A, Shkreli L, Meyer T, Egeri L, Cwik JC, Zlomuzica A, Kessler H, Margraf J. Investigating the effect of proactive interference control training on intrusive memories. Eur J Psychotraumatol 2019; 10:1611092. [PMID: 31143413 PMCID: PMC6522906 DOI: 10.1080/20008198.2019.1611092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 11/30/2022] Open
Abstract
Intrusive re-experiencing is a hallmark symptom of Posttraumatic Stress Disorder (PTSD). According to prominent models of intrusive phenomena, intrusive memories may result from impairments in the efficiency of working memory capacity (WMC), more specifically proactive interference control. Yet, experimental research is scarce. Therefore, the present study aimed to investigate experimentally the role of proactive interference control in intrusive memories. We randomly assigned 57 healthy participants to either receive a high interference control training or a low interference control training. Participants were then exposed to highly distressing film clips. WMC was assessed before and after the training. Intrusion symptoms were assessed directly post-training and after one week using an Intrusion Provocation Task (IPT), a one-week intrusions diary, and the retrospective intrusion subscale of the Impact of Event Sale - Revised (IES-R). Results indicated that both groups reported improvements in WMC and fewer intrusions on the second IPT post-training, with no differences between groups. Similarly, no group differences on intrusions were found at one-week follow-up (i.e., intrusion diary and IES-R). To conclude, these data are not consistent with the hypothesis that WMC plays a role in intrusive re-experiencing. Implications for future research are discussed.
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Affiliation(s)
- Marcella L Woud
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Alexandre Heeren
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium.,Clinical Neuroscience Division, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Lorika Shkreli
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Meyer
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Institute of Psychology, University of Münster, Münster, Germany
| | - Leonie Egeri
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Jan C Cwik
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Köln, Germany
| | - Armin Zlomuzica
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany
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